| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $571 | $399.7 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $571 | $399.7 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $571 | $399.7 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $571 | $399.7 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $571 | $399.7 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $571 | $399.7 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $1,118 | $782.6 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,940 | $1,358 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $4,310 | $3,017 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $3,136 | $2,195.2 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $41,391 | $28,974 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,297 | $4,407.9 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,835 | $1,284.5 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,607 | $1,824.9 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,681 | $1,876.7 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,097 | $1,467.9 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,289 | $1,602.3 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,388 | $2,371.6 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,140 | $2,198 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $622 | $435.4 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $367 | $256.9 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $581 | $406.7 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,976 | $1,383.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,133 | $1,493.1 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,684 | $1,878.8 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,450 | $3,115 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,823 | $2,676.1 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $402 | $281.4 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,950 | $1,365 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,871 | $1,309.7 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,950 | $1,365 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,081 | $1,456.7 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,872 | $2,010.4 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,472 | $1,730.4 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,648 | $2,553.6 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,516 | $2,461.2 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,832 | $1,282.4 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,045 | $1,431.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $628 | $439.6 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $508 | $355.6 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $660 | $462 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $6,530 | $4,571 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $7,664 | $5,364.8 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $534 | $373.8 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $690 | $483 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $4,296 | $3,007.2 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $7,446 | $5,212.2 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,142 | $1,499.4 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,596 | $1,817.2 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,615 | $1,830.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,370 | $2,359 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,750 | $2,625 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,900 | $3,430 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,334 | $2,333.8 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,817 | $2,671.9 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $798 | $558.6 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $797 | $557.9 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,964 | $1,374.8 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $528 | $369.6 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $861 | $602.7 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $904 | $632.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $648 | $453.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $797 | $557.9 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $648 | $453.6 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $481 | $336.7 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,394 | $975.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $381 | $266.7 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $716 | $501.2 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,242 | $869.4 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,068 | $747.6 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,629 | $1,840.3 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | — | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | — | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | — | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | — | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | — | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | — | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | — | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | — | — | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | — | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | — | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | — | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | — | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | — | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | — | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | — | — | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | — | — | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $5,451 | $3,815.7 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $122 | $85.4 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $137 | $95.9 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $138 | $96.6 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $167 | $116.9 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $99 | $69.3 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $96 | $67.2 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $26 | $18.2 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $41 | $28.7 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $87 | $60.9 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $150 | $105 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $182 | $127.4 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $88 | $61.6 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $136 | $95.2 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $198 | $138.6 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $120 | $84 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $5,278 | $3,694.6 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $484 | $338.8 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $3,711 | $2,597.7 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $3,459 | $2,421.3 | — | — | — |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 0 | — | — | — | — | — |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 0 | — | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $299 | $209.3 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $399 | $279.3 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $452 | $316.4 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $477 | $333.9 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $246 | $172.2 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $572 | $400.4 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $614 | $429.8 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $366 | $256.2 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $425 | $297.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $4,822 | $3,375.4 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,674 | $1,871.8 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $7,636 | $5,345.2 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $8,574 | $6,001.8 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $8,890 | $6,223 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $9,289 | $6,502.3 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $8,356 | $5,849.2 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $38,250 | $26,775 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $44,307 | $31,015 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $47,452 | $33,216 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $18,865 | $13,206 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $7,500 | $5,250 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $36,103 | $25,272 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $12,655 | $8,858.5 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $21,604 | $15,123 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $12,594 | $8,815.8 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $29,766 | $20,836 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $17,016 | $11,911 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $32,913 | $23,039 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $17,893 | $12,525 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $14,562 | $10,193 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $16,178 | $11,325 | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | — | — | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | — | — | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | — | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $12,499 | $8,748.95 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $9,376 | $6,563.2 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $3,344 | $2,340.8 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $7,219 | $5,053.3 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $16,641 | $11,649 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $27,675 | $19,373 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $26,341 | $18,439 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $6,896 | $4,827.2 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $17,959 | $12,571 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $13,386 | $9,370.2 | — | — | — |
